Provider Demographics
NPI:1487820544
Name:SINGLETON, JOLENE DENISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:DENISE
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:DENISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N4071 COUNTY ROAD NN
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4415
Mailing Address - Country:US
Mailing Address - Phone:414-640-2977
Mailing Address - Fax:
Practice Address - Street 1:N4071 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4415
Practice Address - Country:US
Practice Address - Phone:414-640-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1444-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36147700Medicaid